Towards a Stakeholder-oriented Health Information Technology Solution for Automated Electronic Information Exchange Between Acute and Post-acute care EHR systems: A Literature Review (Preprint)

Abstract

Using more than one electronic health record (EHR) system from different vendors within a healthcare organization is not uncommon today. Multiple EHR systems within a single healthcare organization arise for several reasons, including strategic mergers and acquisitions (M&A) or using different EHR systems for different episodes of care, such as acute care versus post-acute care services. Information exchange is essential for transitioning high-quality care between care settings. Inadequate or delayed information exchange can result in medication errors, missed test results, significant care delays, and even readmissions. Unfortunately, long-term and post-acute care (LTPAC) facilities often lag behind other healthcare facilities in adopting health information technologies, increasing the difficulty in facilitating care transitions through electronic information exchange. The research gap is most evident when considering the implications of the inability to electronically transfer patients’ health records between these facilities.

This study aims to provide a foundation for understanding the interoperability and information exchange in the context of LTPAC facilities and lay the groundwork for an approach to implement health information technology (HIT) enabled intervention technologies to facilitate automated electronic information exchange between healthcare facilities operating on different vendor EHR systems.

A structured literature review was conducted through PubMed and EBSCOhost, with supplemental searches performed in Google Scholar and grey literature sources like Google. Articles were eligible for inclusion if they were published in English and restricted to the geographical coverage of the United States, published between January 1st, 2015, to May 31st, 2022. The review is approached in three steps to gain an understanding of the state of interoperability and information exchange within the context of the LTPAC setting, the different approaches, tools, and technologies as available in the extant literature, and any studies that attempted HIT-enabled health intervention technologies supporting the information exchange between acute and post-acute care facilities using different EHR systems.

The literature review yielded 27 studies, and the research suggests that only a few HIT-supported intervention studies were found in the biomedical literature. Although HIT is used for information exchange, there are considerable gaps owing to the need for innovative interoperability solutions.

Historically, the interoperability topic has centered on hospital-to-hospital data exchange, making it more challenging to evaluate the efficacy of data exchange between other care settings. The research showed that although LTPAC providers are receiving more attention, this has yet to be converted into a robust, bidirectional information exchange between LTPAC providers and other hospitals. The literature review provides insights into the existing research on the information exchange and HIT challenges at LTPAC facilities. This research establishes a foundation based on which health IT practitioners and future researchers can build a systematic approach to improve an essential health care operational process.